Motorcycle, ATV, Bicycle, and Pedestrian Injuries Practice Questions

25 multiple-choice questions on Motorcycle, ATV, bicycle, and pedestrian injuries for paramedic and EMT students, from Chapter 30 (Trauma Systems and Mechanism of Injury). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Motorcycle riders are at high risk of serious injury mainly because:

   1. A. Motorcycles travel faster than cars on average
   2. B. Helmets shift the force of impact onto the neck and spine
   3. C. Little protection lets the body absorb the energy
   4. D. Bikes carry more kinetic energy than cars
   Show answer

   Answer: C. Little protection lets the body absorb the energy

   Without a steel frame, belts, or airbags, the rider's body takes the energy of the crash. Average speed does not explain the pattern of injury. A motorcycle has far less mass than a car, so it does not carry more kinetic energy at the same speed, and helmets reduce head injury without shifting the harm to the neck or spine.

2. In a head-on motorcycle collision, the rider is typically thrown over the handlebars and may strike them with the:

   1. A. Back, causing lumbar compression fractures
   2. B. Hands, causing isolated wrist fractures
   3. C. Feet, causing calcaneus fractures
   4. D. Thighs, causing bilateral femur fractures
   Show answer

   Answer: D. Thighs, causing bilateral femur fractures

   The bike tips forward and the rider's thighs hit the handlebars as the body is propelled over them. Calcaneus fractures are typical of feet-first falls.

3. In an angular motorcycle impact, the rider's leg is often:

   1. A. Spared because the rider is thrown clear
   2. B. Burned on the calf by the hot exhaust pipe
   3. C. Crushed between the bike and the other object
   4. D. Injured below the ankle by the foot peg
   Show answer

   Answer: C. Crushed between the bike and the other object

   When the bike strikes an object at an angle, the rider's leg can be trapped and crushed, causing open fractures or amputation. Exhaust burns can occur but are not the major injury.

4. A rider who intentionally lays the motorcycle down to avoid a collision most often suffers:

   1. A. Bilateral femur fractures
   2. B. Abrasions and road rash
   3. C. Severe closed head injury
   4. D. Posterior hip dislocation
   Show answer

   Answer: B. Abrasions and road rash

   Laying the bike down slows the rider and keeps the body away from the bike, but sliding on pavement causes extensive abrasions. Protective leather or reinforced gear reduces this.

5. Motorcycle helmets are effective at reducing:

   1. A. Head injuries and deaths
   2. B. Cervical spine injuries
   3. C. Lower extremity fractures
   4. D. Chest and abdominal injuries
   Show answer

   Answer: A. Head injuries and deaths

   Helmets reduce the risk of head injury and death substantially. They offer little protection to the neck, chest, abdomen, or legs.

6. A helmeted motorcyclist is alert and breathing adequately but complains of neck pain. Regarding the helmet you should:

   1. A. Leave it on unless it interferes with care
   2. B. Remove it at once to inspect the scalp for wounds
   3. C. Have the patient take it off himself
   4. D. Remove it so a cervical collar fits
   Show answer

   Answer: A. Leave it on unless it interferes with care

   A well-fitting helmet can stay on when the airway and breathing are manageable and spinal motion restriction can be maintained; padding under the torso keeps the spine neutral. Removing it at once to look at the scalp adds spinal movement without a life-saving reason. Letting the patient remove it himself produces uncontrolled neck movement. Applying a collar is not a reason to remove a well-fitting helmet; if removal is needed for airway access or a poor fit, use a two-person technique with manual stabilization.

7. ATV crashes frequently involve:

   1. A. Low-speed injuries limited to the hands
   2. B. Burns from the engine as the main injury
   3. C. Injuries mainly among toddlers under 5
   4. D. Rollovers with crush injury and ejection
   Show answer

   Answer: D. Rollovers with crush injury and ejection

   All-terrain vehicles have a high center of gravity and tip easily, and the rider can be pinned under a vehicle weighing several hundred pounds. Children are disproportionately hurt, but adults are injured too.

8. Under the 2021 field triage guideline, a rider separated from a motorcycle, ATV, or horse with significant impact meets:

   1. A. A red injury pattern criterion
   2. B. A yellow mechanism criterion
   3. C. No criteria if the rider wore a helmet
   4. D. A red criterion if the speed was high
   Show answer

   Answer: B. A yellow mechanism criterion

   Rider separation with significant impact is a moderate-risk mechanism that directs transport to a trauma center. A helmet does not change the criterion.

9. A cyclist who strikes a car door that opens in front of him often injures the:

   1. A. Calcaneus and lumbar spine from axial load
   2. B. Lower legs, from the pedals
   3. C. Head, upper extremities, and chest
   4. D. Pelvis, from the saddle
   Show answer

   Answer: C. Head, upper extremities, and chest

   The rider is thrown forward into or over the door, striking the head and outstretched arms. Calcaneus and lumbar injuries are typical of feet-first falls.

10. A 12-year-old boy fell forward onto the handlebars of his bike. He has epigastric pain. You should suspect injury to the:

    1. A. Kidneys and ureters
    2. B. Pancreas or duodenum
    3. C. Lower lumbar spine
    4. D. Urinary bladder and urethra
    Show answer

    Answer: B. Pancreas or duodenum

    A handlebar strike concentrates force on a small area of the upper abdomen, compressing the pancreas and duodenum against the spine. Pain may be mild at first and worsen over hours.

11. When an adult pedestrian sees a car coming, the adult typically:

    1. A. Turns away, so impact is lateral or posterior
    2. B. Faces the car, so injuries are mostly anterior
    3. C. Drops to the ground before the impact
    4. D. Jumps up onto the hood of the car first
    Show answer

    Answer: A. Turns away, so impact is lateral or posterior

    Adults instinctively turn, so the bumper strikes the side or back of the legs. Children tend to face the vehicle, producing a different pattern.

12. The first impact in an adult pedestrian struck by a car is usually the bumper hitting the:

    1. A. Pelvis and hips
    2. B. Lower chest
    3. C. Head and neck
    4. D. Lower legs
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    Answer: D. Lower legs

    In adults, the bumper reaches about knee level, causing tibia and fibula fractures. In a child the bumper hits higher, at the femur or pelvis.

13. The classic pattern of injuries in a child struck by a vehicle is known as:

    1. A. Cushing's triad
    2. B. Beck's triad
    3. C. Waddell's triad
    4. D. Charcot's triad
    Show answer

    Answer: C. Waddell's triad

    Waddell's triad is the bumper striking the femur or pelvis, the hood striking the chest or abdomen, and the head striking the ground. Cushing's triad signals raised intracranial pressure.

14. In Waddell's triad, the child's head is usually injured by:

    1. A. The bumper at first contact
    2. B. A seat belt inside the vehicle
    3. C. Striking the ground or the vehicle
    4. D. Being crushed under the rear wheels
    Show answer

    Answer: C. Striking the ground or the vehicle

    Children are light and are thrown forward or under the car, and the head strikes the ground. The bumper hits the femur or pelvis because of the child's short height.

15. A 7-year-old was struck by a car while crossing the street. He has a deformed left thigh and abrasions to the chest. You should also strongly suspect:

    1. A. A lumbar compression fracture
    2. B. A dislocated right shoulder
    3. C. Bilateral calcaneus fractures
    4. D. A head injury
    Show answer

    Answer: D. A head injury

    In Waddell's triad, femur and chest injuries come with head injury from striking the ground. Even if the child is alert, a head injury must be assumed and assessed. Lumbar compression and heel fractures come from axial loading in falls onto the feet, not from a vehicle striking a child.

16. A pedestrian struck at a higher speed is often scooped up onto the hood. In addition to leg injuries, expect injuries from the:

    1. A. Hood and windshield striking the torso and head
    2. B. Rear tires running over both arms and legs
    3. C. Exhaust system burning the lower back skin
    4. D. Undercarriage crushing both of the feet and ankles
    Show answer

    Answer: A. Hood and windshield striking the torso and head

    The second impact is the torso and head hitting the hood and windshield; the third is the body striking the ground. Run-over injuries can happen but are not the typical second impact.

17. When a pedestrian is struck, which three impacts are generally described?

    1. A. Ground, then bumper, then the windshield
    2. B. Bumper, hood or windshield, then ground
    3. C. Windshield, then ground, then bumper
    4. D. Hood, then ground, then rear tires
    Show answer

    Answer: B. Bumper, hood or windshield, then ground

    Each impact can cause its own injury, so the patient may have injuries on several sides of the body. The ground impact often produces head and spinal injury.

18. Under the 2021 field triage guideline, a pedestrian or cyclist who is thrown, run over, or has significant impact meets:

    1. A. A red criterion for the highest level
    2. B. A yellow criterion for a trauma center
    3. C. No criterion unless the speed was high
    4. D. A criterion if the patient is a young child
    Show answer

    Answer: B. A yellow criterion for a trauma center

    These are moderate-risk mechanism criteria. If red injury patterns or vital sign criteria are also present, the patient goes to the highest-level center.

19. A 70-year-old woman was struck by a car backing out of a driveway at low speed. She is alert, BP 108/70 mmHg. The best transport decision is:

    1. A. Highest-level trauma center, based on SBP
    2. B. Nearest hospital, since the speed was low
    3. C. Release, since she has normal vitals
    4. D. Urgent care for an x-ray of the legs
    Show answer

    Answer: A. Highest-level trauma center, based on SBP

    For a patient 65 or older, SBP under 110 mmHg is a red criterion. Low speed does not make an elderly pedestrian's injuries minor.

20. A child darted between parked cars and was struck by an SUV. Compared with a sedan, the SUV is more likely to strike the child's:

    1. A. Ankles and the lower legs
    2. B. Feet and heels
    3. C. Chest and head directly
    4. D. Knees and lower shins
    Show answer

    Answer: C. Chest and head directly

    Higher bumpers and hoods strike higher on the body, so children hit by trucks or SUVs often have direct chest and head injuries. Ankle injuries are more likely with low bumpers and adults.

21. The patient most likely to be run over after being struck by a vehicle is a:

    1. A. Tall adult
    2. B. Motorcyclist
    3. C. Adolescent
    4. D. Small child
    Show answer

    Answer: D. Small child

    Small children are often knocked down and pulled under the vehicle rather than thrown onto the hood. Tall adults usually ride up onto the hood.

22. A motorcyclist was ejected and landed 40 feet from the bike. He is responsive to pain, RR 32/min, BP 86/50 mmHg. Your priority is to:

    1. A. Manage the airway and bleeding and transport rapidly
    2. B. Splint every extremity fracture before moving him
    3. C. Obtain a complete history of the crash
    4. D. Remove his helmet to check for scalp wounds
    Show answer

    Answer: A. Manage the airway and bleeding and transport rapidly

    He meets red criteria for mental status, respiratory rate, and SBP, so limit scene time and treat life threats en route. Splinting every fracture on scene delays definitive care.

23. Which motorcycle rider protective gear reduces the severity of road rash?

    1. A. Heavy cotton jeans and a hoodie
    2. B. Reflective vests worn over a riding jacket
    3. C. Leather or abrasion-resistant clothing
    4. D. A back protector under a T-shirt
    Show answer

    Answer: C. Leather or abrasion-resistant clothing

    Abrasion-resistant clothing protects the skin as the rider slides. Reflective vests improve visibility, which helps prevent crashes but does not protect against road rash. Cotton denim and fleece wear through within a short slide, and a back protector guards the spine against impact but leaves the skin unprotected from abrasion.

24. A cyclist was hit by a car and thrown 15 feet. He wore a helmet that is now cracked. This finding indicates:

    1. A. The helmet failed and caused injury
    2. B. A head injury is now unlikely
    3. C. The helmet absorbed the force safely
    4. D. Significant energy reached the head
    Show answer

    Answer: D. Significant energy reached the head

    A cracked helmet means it absorbed a large force, and the brain may still have been injured. Treat the head as injured and report the helmet damage to the receiving team. Helmet damage is a reason for more concern, not reassurance; it does not mean the force was safely absorbed or that head injury is unlikely.

25. A teen on an ATV was pinned under it after a rollover. Bystanders lifted it off. He has a distended, tender abdomen and a pulse of 130/min. You should suspect:

    1. A. Abdominal wall bruising from the frame
    2. B. Intra-abdominal hemorrhage from crush
    3. C. Tachycardia from pain and fright
    4. D. A strain of the abdominal muscles
    Show answer

    Answer: B. Intra-abdominal hemorrhage from crush

    Crush under a heavy ATV can injure the liver, spleen, and pelvis, and tachycardia with abdominal distension signals hemorrhage. Pain, fear, wall bruising, or a muscle strain may cause tenderness or a fast pulse, but none of them explains a distending abdomen; assume internal bleeding.